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Adenomyosis
Adenomyosis is defined as the presence of endometrial islands within the uterine wall, typically affecting women over 40, though younger women can also be affected. Clinical features include menorrhagia, dysmenorrhea, and pelvic discomfort, with MRI being the preferred diagnostic tool due to its superior accuracy. Management options vary based on age and patient interest, ranging from hysterectomy to medical treatments like NSAIDs and hormonal therapies.
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Adenomyosis
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- 2. DEFINITION ETIOPATHOGENESIS CLINICAL FEATURES GROSSFINDINGS HISTOLOGICAL FINDINGS MRI FINDINGS MANAGEMENT
- 3. DEFINITION Presence ofendometrial islands within the uterine wall i.e., myometrium Usually endometrial glands are present only in endometrial layer of uterus ,which gets sloughed off regularly during menses But in this condition there occurs signifying down growth of endometrial tissues into the myometrium
- 4. ETIOPATHOGENESIS Elderly womenaged above 40 Younger women are also susceptible No clear pathogenesis . Believed as an endometrial tissue down growth ASSOCIATIONS: • Uterine fibromyomas • Pelvic endometriosis • Endometrial carcinomas
- 5. CLINICAL FEATURES Presentwith menorrhagia & progressively increasing dysmenorrhea Pelvic discomfort, backache, dyspareunia Painful symmetrical enlargement of uterus suggests adenomyosis following investigations Uterus size- resembles 3 month pregnancy Uterus may be symmetrically or asymmetrically enlarged MRI is superior to USG for diagnosing adenomyosis
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- 7. GROSS FINDINDS (CONTD…) Uterus appears symmetrically enlarged resembling not more than 14 weeks size Asymetrical enlargement of uterus may also be seen in some cases which may confused with myoma Affected area shows peculiar and diffuse involvement of myometrium Posterior wall- dark hemorrhagic areas in b/w normal areas Cross section shows localized nodular enlargement Enlargement-due to hyperplasia of smooth
- 8. HISTOLOGY ENDOMETRIAL ISLANDPRESENT DEEP WITHIN STROMA(MYOMETRIUM)
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- 10. MANAGEMENT HYSTERECTOMY withor without salpingo- oopherectomy - if women aged 40 years above and indicated If not interested or if she is young • NSAIDs (medical) • GnRH(hormonal) • Mirena IUCD • TCRE(trans cervical resection of endometrium)
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